The Opioid Crisis Is Not About Opioids

The Opioid Crisis Is Not About Opioids

Ultimately the “opioid crisis” is not about opioids, it is about addiction and mental health and societal despair. In fact, the majority of drug overdose deaths are due to multiple substances, including alcohol and benzodiazepines, not just opioids. The real crisis we are facing in this country is a substance abuse problem, not an opioid abuse problem.

The hysteria around opioid use for chronic pain is wrong and not supported by the facts. Studies show that among people who are prescribed opioids, addiction is relatively uncommon. According to a brilliant article by Dr. Sally Satel, “the percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent.”

It is important here to clarify the difference between addiction and dependence. Because of how opioids affect the brain, anyone taking this type of medications regularly will develop physical dependence on them, meaning if the medications are stopped suddenly withdrawal symptoms may occur. Dependence is not the same as addiction. Addiction means abnormal behaviors around a medication, using it to change your mood or get high, and being unable to control your use of the medication.

Ginevra Liptan, MD

Ultimately the “opioid crisis” is not about opioids, it is about addiction and mental health and societal despair. In fact, the majority of drug overdose deaths are due to multiple substances, including alcohol and benzodiazepines, not just opioids. The real crisis we are facing in this country is a “substance abuse” problem, not an opioid abuse problem.

In a powerful editorial in Pain Medicine News, Dr. James Choo, a Tennessee pain physician, says it perfectly: “The opioid crisis has caught the nation’s attention, but through the lens of opioids we focus on a narrow bandwidth and overlook the deeper problems… of addiction, trauma and polysubstance abuse.”

In fact, the policies to control one type of drug use often cause a flourishing of another type. As prescription opioids became harder to access, more people turned to stronger illicit fentanyl and heroin, which are much more likely to lead to deadly overdose. In fact, as this powerful graph shows, as prescriptions for opioids went down, rates of overdose deaths have gone up.

Clearly the current efforts to clamp down on opioid prescriptions are misguided. During prohibition when alcohol was illegal, people turned to homemade alcohols and toxic wood alcohol (methanol) that caused blindness and death. Our current “opioid crisis” looks a lot like a deadly game of whack-a-mole, as we chase after the current drugs of abuse, while not addressing the underlying demand for drugs.

According to Dr. Choo, the better question is why do addicts seek any drug? The answer is likely trauma, a societal affliction that most policymakers and the media are uncomfortable addressing. A study in the 1990s by the CDC and Kaiser Permanente found that the amount of trauma experienced in childhood was directly related to the risk of developing addictions. Some addiction experts now think that substance abuse may be a normal learned response to trauma, a form of compulsive comfort-seeking or self-soothing. Dr. Choo advocates changing the narrative from an “opioid-crisis” to a “trauma crisis” and “directing resources and attention to addressing what drives the demand for drugs, but this would take political and societal will, and it takes a long view to care—not a quick fix by any means.”

He is absolutely right. We cannot win by playing an eternal game of “whack-a-drug”, without addressing the underlying societal ills driving substance abuse and addiction. Responding to a substance abuse epidemic by taking opioids away from those in chronic pain simply creates an epidemic of undertreated chronic pain.

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Authored by: Ginevra Liptan, MD

Ginevra Liptan, MD, developed fibromyalgia while in medical school. She is a graduate of Tufts University School of Medicine and board-certified in internal medicine. Dr. Liptan is the founder and medical director of The Frida Center for Fibromyalgia and the author of The Fibro Manual: A Complete Fibromyalgia Treatment Guide for You...And Your Doctor and The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief.

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Cynthia

An interesting article, with many truths…but it covers too much ground. Please, Dr. Liptan , write and send an article to President Trump and attorney general Barr , defending all of us who fit within the parameters of your final paragraph. Thank you

Trauma is a major cause of addiction. ACE’s (adverse childhood experiences) are the #1 in that category. But how these cause addiction is what conventional medicine can’t comprehend. However, it is all explained on the video The REAL Cause of Drug Abuse here: http://www.doctorsofcourage.org/videos/. Addiction can be prevented and cured. Learn how and spread the word. This is the only way the attacks on opioids can be stopped.

Jasmin Days

Thank God someone understands this craziness. I have Lumbar Post-laminectomy Syndrome and am in horrible pain in my lower back every day on a constant basis and these people need to try to walk in my shoes. Ha!

Linda

I agree with what Ken had to say! However, I’m not nor have I ever been addicted to alcohol or drugs but I do take a small amount of opioids for years! And guess what? I’m not addicted to them. I’ve been taking them for years and yet I still forget to take them! Why is the Government allowed to tell doctors what and how much they can prescribe to their patients when they didn’t go to college as long as Doctors have? You can bet your ass that anyone in Congress & The House of Representatives even The President can buy a Doctor and get as much opioids they want! You know that’s true!

Kathy Olszewski

Thank God someone understands!

Ken

I am no doctor, but always have said these same things about addiction, drugs, and the deaths caused by them. The normal narrative is incomplete, incorrect, and destructive. Thank you very much for the article Dr. Liptan. I hope many see this and start the proper discussions.
P.S. I am a recovering addict and feel my opinion on this is as valid as any other if not more than some. This is the first time vie read something on the “opioid crisis” that is truly thoughtful of reality.

Don Prue

One to two percent of prescribed opioid patients either accidentally or intentionally overdosing is not a crisis. 40,000 people being killed on the highway is a crisis. But the media decides what is a crisis.
Ever since the DEA deputized doctors the hippocratic oath went down the toilet…THAT IS A CRISIS!
Having constant untreatable pain is a crisis. Having people make laws and policies preventing chronic pain patients from relief is a crisis. Suicide rates among veterans is a crisis.
I am so mentally and physically exhausted from the stress, lack of sleep and anxiety worrying what I’m going to do when the ONLY drug that provides me a modicum of relief is no longer available to me or is no longer effective unless the dosage is increased that I finally understand why people are driven to suicide.
My constitution and integrity prevents me from ever using street drugs, yet I am treated/viewed as if I’m ‘just another junkie.’
I was born with scoliosis but refused to accept that it was a limitation so I went into the Marine Corps to prove to myself that I was ‘normal.’ I worked hard, labor intensive jobs and that is how I earned my first back surgery. I continued to work and act ‘normal’ and that resulted in six more surgeries. Now I’m left with pain that can no longer be ignored.
Why do I and others like me who DO suck it up have to be punished by “the system”? One comprised of rule makers with no representation by the very people who have to live by these rules that prevent us from any sense of a normal w?!

Linda

Has anyone noticed the terminology has changed in regard to addiction treatment for the addicts? It’s not opioid abuse or opioid addiction. It’s now called OPIOID USE DISORDER.

Yet for Chronic Pain Patients it remains “Chronic Opioid Use” or addiction in our medical printouts we get everytime we leave our doctor offices. That has always bothered me, I mean based on that logic, my record should say that about all of my monthly prescriptions. The only reason my printout says that anyway, is because of the pain medicine THEY have had me on for years, not because of anything else. If you REALLY want to get down to it, neither title is appropriate.

I read doctor Choo article in pain medicine news.com, the article it’s worth reading but there was no chart / graph. I would agree with him on asking the person why do you do what you do if you’re a drug addict. I agree trauma could make a person an addict but it doesn’t make all people that have traumatic experiences become addicts. I meant a preacher who goes around talking about his childhood abuse being sexually abused that he chose God & not drugs, I kn a person who was in Vietnam who said he had to shoot a young boy that had bomb strapped on him to protect the troops in a truck, he wrks @ gov facility that u need gov back ground ck, he not a chronic pain person nor a addict or drink alcohol. I have so many more stories like that so just saying someone had a traumatic experiences make them an addict is excuse. This also would mean that anyone that went to war served our country would be considered someone who had something traumatic happen there for any service member could not receive pain treatment because then they would automatically be looked at as an addict? Who gets to decide that an experience is traumatic to that person? Say that you got in a fight in high school or car wreck would that be considered a traumatic experience? Who would decide it’s traumatic the person that happened to or the doctor? I think who’s opinion to decide is a slippery slope to be labeled as a addict over something that happened it’s no big deal to the person that happened to but physician could use that against the patient for no pain treatment with opiates.

Thomas Kidd

I voted for Trump, and I don’t really regret it the alternative was not an option. But Trump has allowed this torture and the taking away of our rights under the Americans with Disabilities Act. I will not be voting ever again. I have suffered 30+ years with daily chronic pain and if I am suddenly taken off the Methadone I have taken all these years I will not survive long. My wife is in the same shape. How can I go to the poles and vote for someone who has had a big hand in causing mine and millions of others more suffering!? I cannot. It’s horrible that people who would never think of going to the streets for pain relief are doing just that by the thousands. No, I will not be a part of this hellish anti-christ system. If it comes to it I will just place myself in Jesus’s capable hands and die. I recommend to one and all my Redeemer, Jesus Christ to King. Praying for all who are suffering because of this out of control government policy. Perhaps Mr Trump will be humbled into changing his mind or losing the election. But I fear that if the liberal socialist who are running against him will be 10 fold worse. Lord Jesus come soon.

Thomas Kidd

Thank you Doctor. I appreciate this truthful look at the problem.

Laurie

Hey folks these are the Dogs of War ( DEA) released on a vulnerable population, disregarding people who require government programs. Trump released them and YOU know it.
He would laugh at your pain and mock you if he read anything at all.
Now, he’s trying to go after the homeless and put THEM in cages too.
Wake up, forcryingoutloud!

By the way, if you get a menacing call from the DEA telling you you need a criminal lawyer…it’s a scam. Don’t freak out

Sue

Unfortunately the state medical boards have made it more difficult to care for chronic pain patients. We are being monitored and have to be very careful about prescribing in order to keep our licenses.

Beth

As a result of the opioid hysteria, I have lost my pain control and I cannot agree more with this article. It ought to be in the mainstream media that is demonizing opiates. One thing I would add is that our government’s lawsuits against opiate makers and distributors is going to make federal and state governments and municipalities a lot of money that they do not want to pass up. I cannot see anything changing for chronic pain patients any time soon.

Thank you from someone who suffers debilitating chronic pain daily as a result of “opioid crisis”. I was prescribed Oxycontin 20 mg for 23 years and then they were taken away. My life as i knew it is over. I have so much pain I can’t work, so we’re broke and most days i want to die. Never have i had an addiction to these pills even now I don’t crave them or go to streets and buy them! Great point!

Kathleen Ganley

I have been asking the same question as Reece. Why aren’t the people who understand what is happening to the chronic pain community speaking out to the media? What about the senator who wrote to the DEA we read about recently here in an article? Why won’t he speak out about this? Any followup on that? Why won’t the CDC and FDA. who have recently clarified their guidelines regarding chronic pain patients, speak up through the media?

Denise Morris

Thank you Dr. Liptan for such a well-described explanation of the situation. I hope this article
reaches widespread readers, especially those who can broadcast the truth further!

Dr.Choo, He has horrible reviews on Google & people that I kn who have seen him say he pushes the injections. No pain meds. Dr. Choo is incorrect that trauma causes illicit drug use. I have kn people that have gone thru some horrific things & they are the best Christians & some were not Christians but they’re not illicit drug users nor drink alcohol. 1960s LSD was created for mental health problems but there were young people using it just bc their peers used. What about when there was a LSD, Quaaludes, marijuana problem. There’s still a overconsumption of alcohol / DUI. Alcohols not pulled off the shelf . There is no way to solve addiction BC people are going to choose to do what they want to do bottom line. Whether it’s destructive / beneficial to their health. There has been & always will be trauma in the world how r they going to chase down what happened to each person. when a person says they r in pain that = them as having trauma? BC u now have to see a psychologist 4 P.M . Running people thru a strainer it’s not going to wrk cuz people can lie. This whole thing is going in circles. DR. Choo only saying that as a way to protect his job & just sound like he kns what he’s talking about. The issue is personal responsibility & the gov can’t totally control that. Drs love to label things but yet there r a lot of dr’s that steal pain meds & use them. 1 Dr giving advice to TN on guidelines for the state admitted to taking patients medicine BC he was overworked. No trauma. I kn surgeon ex wife he did same thing. U.TN medical center had lock up pain meds bc staff stealing it. They r not naive pain patients but very educated, again no personal responsibility. If Dr Choo develop intracable pain = him as having trauma / addict if he ask for pain medicine?

James H Mcfarland

Its not an opioid crisis it’s a pusher crisis manufactured by the doctors and the pharmaceutical companies.

Perfectly said!! Not that I’m patting myself on the back BUT… I’ve commented on the NPR numerous times over the past 5 yrs that this is mistakenly called the OPIOID CRISIS when it should be called an ADDICT CRISIS. I have also written that in my opinion the addict crisis stems from the societal issues in this nation. The past couple of generations have increasingly grown up in and with the stiruggles of single parent homes, poverty has increased, decreased jobs rates have risen, morals have diminished, self esteem and self worth issues are rampant, self centerness has increased, anger is rampant, no one owns up to their own faults, our nation has lost having its eye on God and on respecting others… Etc etc. It is ‘society’ in America! To me, it is all common sense.
Thank you Dr. Choo for also bringing this thought to light. 🙂

Are we NOT THE USELESS EATERS to our government and the CDC? If not explain this to me;
I have severe pain and nerve impingmen affecting my neck, shoulder and left arm. The neurologist advised surgery to alleviate the nerve pain and fusing 3 vertebrae with a metal plate. I have had 2 lower spinal surgeries 30 years ago and know how managing the pain allowed me to go through physical therapy and strengthen my back and return to heavy work for decades.
These surgeries did not include metal.hardware and I know the pain that goes along with this.
I asked neurologist how he would help me control pain following surgery? He replied 3 to 5 days post surgery then Motrin. I never abused opoids and the only time I almost did lose my life was while taking Motrin I had a digestive bleed. I was in critical condition from Motrin, not any opoid and almost died. I will never take this again
That being said I will never go through a surgery that involves weeks! Not days, of severe pain post operative!.
So what am I to think when a major news station reports That a big name model broke her arm and has had to be on heavy pain medications for 10 days and counting? Didn’t her doctors get the memo from the CDC?
Or do the “SSignificant ones”, get what they want for as long as they want
….. While every other chronic pain patient suffers and loses quality of life from this insane attack on the very thing that made life possible???

Deb

Thank you Dr Liptan. I was tapered down on opioids for chronic pain. It was and is a struggle every day. Now I take more ibuprofen so as not to take more opioids and Dr wants me to stop as I have ulcers. My latest blood tests showed abnormal readings for my liver and kidneys…I don’t drink alcohol. The doctor suggests it may be the ibuprofen. So what do we do? Thank you for speaking out. Deborah

Pamela Stachler 258

I so completely agree with everything that’s been said here. I’m 63 years old and a chronic pain patient dying from cirrhosis of the liver I have never seen anything like this in my life. I am trying to move home from Florida back to Ohio to be with my daughter because I’m very very sick and the only thing preventing me from moving right now is I cannot find a primary care physician that will prescribe the low dosage chronic pain medication Oxycodone to me and I use it as prescribed. Millions of us use it as prescribed and we don’t overdose or commit suicide. We don’t want to live the little bit of our life that we have left and retirement after working all of our Lives to get here in chronic pain and can’t even enjoy taking a hot shower. This is ridiculous!

Cindy

Interesting. But I’ve had several traumas in my life and a PTSD diagnosis, and have never become addicted to anything.

During times of acute stress, there were times that I used alcohol to self-medicate, but eventually when the stress eased up, so did my alcohol use.

I’ve been on opioids for over a decade and am not addicted to those either. On days that aren’t horrific, I take fewer percocet than on horrific days.

I even sometimes forget to take my bedtime or mid-day methodone.

Not the actions of an addict.

In spite of the traumas I’ve suffered.

Martha

Great article. Beautifully written. Kudos. Our CP community should print this and bring or mail this to their local Hospital Presidents… nationwide. If anyone can find a politician who isn’t afraid to listen & learn, ot God forbid…The Media, then by all means… mail to them as well.

Alice Carroll

I’ve written several times to 60Minutes and to President Trump. Neither have replied. They aren’t interested in chronic pain patients, we are a drain on society to them. If you’re not providing big campaign cash, patronizing his hotels or helping to obtain a multi-billion dollar judgement on Big Pharma you are of little significance. The author is correct. The true question is “Why is our society turning to drugs and alcohol?”

My theory is we are taught (advertisers coerce) that we can buy our way to happiness. Americans are in a great deal of debt because we are living beyond our means. This creates pressure to repay so you must work and not complain. You have no bargaining power when you’re in debt. The loss of good paying jobs leaves a vacuum of not only income but self pride. If you can’t pay your bills the interest (28% on some) will eat you alive. Couples feud over money, there is little to no safety net. I wonder how many drug OD’s are actually suicides?

I see drug use as a cry out for help. Jailing people for drug use is the wrong approach it makes things worse. Let’s try what they do in Europe. No jail time for simple possession, but counseling and job retraining. We need hope! People need to feel wanted and loved. Instead our leaders pit group against group blaming others for the problems that their policies have created and that they profit from. This is why things never seem to change. We’ll spend billions on a wall that will do nothing when we could be putting it towards thwarting climate catastrophe. That would mean creating good jobs to save our planets future.

Vicki

Thanks you!!! I wish this would be required reading for all. I have more fear for people who are on benzos than opioids. Or when they mix the two with alcohol. And withdrawal from benzos is life threatening as I understand it. Opioid withdrawal is just pure hell. I do have a dependency issue and live in fear that I my prescription will not be filled and not only will I be left with pain but awful withdrawals suddenly. But when you act desperate for your script to be filled you are treated like an addict. I am so tired of the ignorance surrounding this issue. This post is excellent. Also the one about the alternative meds used for pain. The side effects and the withdrawal from some are also very bad. When will this stop. Many thanks to those of you speaking out. God bless.

J.D.

What is needed is the other side of the story to get out there. All that is ever talked about is the lives lost due to opioids but I am thinking it is time to take a different approach and write up something about all the people that had their lives saved and even made better due to their use of prescription opioids that were prescribed legally by a doctor or pain clinic due to an actual medical need to help with their pain. This seems to be something that the media might just latch onto as an interesting look into the real world of prescribed opioids and not just the usual hatchet job of throwing anything into the “Opioid Crisis” which we all know is actually an illegal Heroin/Fentanyl problem at it’s core.

Katie Olmstead

Exactly! I’d like to see this article shared on a wider spectrum. I am going to share it with my elected representatives who I know personally.

Allison Higgins

While growing my sister never had a surgery, so therefore she never had opioids. Her drug of choice was crack cocaine. She will tell you that she started crack with her poor choice of friends. I have had several surgeries while in high school and given opiod. I am 54years old and do not drink, smoke or do drugs. Imagine that I had opioids while growing up and you could not pay me to do drugs. My mother was a terrible alcoholic and watching her drink and watching my sister sell her soul to the devil doing crack left me with absolutely no desire to indulge in those things. I made myself accountable for myself.

I agree 💯 %…the crisis is as you stated…and no affordable AND affective treatment for addiction!!!
I’am a CPP and a 10 year active member of AA. I see the real “crisis” all the time! What I don’t understand is addiction is a brain disease so doctors should know this!( I’m also a retired ER RN) Also, if you don’t have this disease…you WONT be a addict!! I think tolerance to medication and the high amounts some people take add to the problem!! CPP were thrown under the bus and scapegoats so the greedy couldn’t be to blame! Thank you for setting the world straight!!!

nana

It is also and mostly about money.

To fill lawyers pockets and to fill county/state/fed pockets as they are just about out of tobacco settlement money.

Patricia Bradley

Why doesn’t the CDC just admit they were wrong to let this go on.? They have the means to make this change and get the chronic pain patients the help they need.
To let people continue to suffer is wrong. They know they can change it do why are they silent?

Reece

Why can’t some of these doctors with expertise in the field get to the media such as 60 Minutes and NBC? The journalists only interview people who use scare tactics. Rarely is the real truth told about the chronic pain patients and how they are suffering due to the lies that have been spread. The best awareness needs to reach the media.

Lisa Hess

Ms. Lipton, from your written type to the Government’s eyes! Chronic patients understand and know all of this, but it seems we are the only ones.

Randy

I agree, but where does that leave us. I support President Trump as President. He needs to be informed that his nation has an epidemic of chronic pain patients that do not abuse drugs. Do not try to commit suicide or over dose intentionally. Just because they have pain. We need a national paradigm shift in what is the opoids crisis really about.

Pamela Aylor

Where is the graph mentioned in the article?

Claudia

Thank you Dr. Lipton..I appreciate you taking the time to help us chronic pain patients . I never asked to get hurt at work it’s has and is a rollar coaster .now w such serios problem s multiple surgeries .back and neck at time s I am lucky enough to walk a few blocks . Plus opioid ok but my muscle relax .bummer Advil alieve tylonal ECT orc thank you Claudia

Jud

There are two victims in this, first, the people who have to live with incurable chronic pain medical problems who are denied medicine that helps them manage pain levels. Now, a second group, people with mental health medical problems who are being lumped in with others who have addiction problems. Do no create a second group of victims.

William burns

The pharmaceutical companies who have been found to have used marketing tools in creating this nightmare for patients of chronic pain should be made to pay reparations directly to all of us who have been left to suffer even more needlessly. We need a class action lawsuit against all doctors,pharmaceutical companies,and anyone else in the world of chronic pain that’s pushed this agenda. You will get there attention then.

Virginia

Why isn’t this being sent to Trump? He’s a reasonable man when he gets the facts. All he hears from is those like Kolodny. This is a very well written piece. Thank you.